Hung-Fat Tse

3rd February 2015

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Hung-Fat Tse (chair professor of Cardiovascular Medicine and William MW Mong Endower professor in Cardiology, the academic chief in the Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong) specialised in electrophysiology at the time when the discipline was starting in Hong Kong. While his initial research interests focused on device therapy for cardiac arrhythmias, he has dedicated his career to the development of cardiovascular regenerative medicine. The Research Center of the Heart, Brain, Hormone and Healthy Aging, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, where he is deputy director, has contributed to advances in biological therapies for cardiovascular diseases with research on biological pacemakers and the use of autologous bone marrow stem cells for treatment of chronic myocardial ischaemia. Tse has published over 420 original scientific reports in international scientific journals and is co-chairman of the CardioRhythm conference (30 January–1 February 2015, Hong Kong). More details of Tse’s career are summarised in this interview with Cardiac Rhythm News.

What prompted your decision to specialise in cardiology and electrophysiology?

During my first resident rotation in internal medicine, I took the basic cardiology training. I decided to specialise in electrophysiology because I was inspired by the advances in cardiac pacing and clinical electrophysiology as catheter ablation was just starting in Hong Kong.

Who are your mentors?

My mentors are Prof Chu-Pak Lau and Prof Fred Morady.

Which innovations in cardiology/electrophysiology have shaped your career?

The innovations in cardiology and electrophysiology that have shaped my career are catheter ablation and antithrombotic therapy for atrial fibrillation. I have also focused on gene and stem cell therapy for cardiovascular diseases.

What research areas have you been most interested on?

My initial research interests are on cardiac pacing and device therapy for cardiac arrhythmias. We are the first centre in Asia to implant standalone atrial defibrillators and also subcutaneous implantable cardioverter defibrillators (ICD) for the treatment of cardiac arrhythmias. Our lab is also one of the pioneers in the development of a biological pacemaker using gene therapy, and use of autologous bone marrow stem cells for treatment of chronic myocardial ischaemia.

What are you currently researching on?

Use of pluripotent stem cell platform for diagnosis, modelling and drug screening for inherited cardiovascular diseases.

You have contributed significantly to research in cardiovascular regenerative medicine; what clinical questions in the field would you like to see answered?

Despite the initial promising results on the use of stem cell therapy for the treatment of cardiovascular diseases, the optimal cell therapy remains unclear. Future studies need to address whether the use of pluripotent stem cells-such as induced pluripotent stem cells or embryonic stem cells derived cardiomyocytes-in combination with the latest technology in bioengineering can further improve the efficacy of stem cell therapy.

Of the research you have seen in the past year, which did you find the most interesting and why?

I think the discovery of the induced pluripotent stem cell is one of the major breakthroughs in science as this technology provides novel insights into the mechanism and therapeutic potential for regenerative medicine.

How far are we to have biological therapies for heart rhythm disorders?

Our lab and others have published several important proof-of-principle studies on the development of biological pacemakers using gene and cell therapies; however, the long-term safety and feasibility of these biological therapies remain unclear. Moreover, the latest developments of leadless pacemakers also reduce the interest on the development of biological pacemakers. On the other hand, advances in the understanding and diagnosis of inherited cardiac arrhythmic syndromes, such as Long QT syndrome using different stem cell modelling is providing new insights and biological therapies for those disorders.

Could you tell us what has your most memorable case been and why?

Recently, I saw a family who presented with progressive cardiomyopathy and was subsequently diagnosed to have Danon disease. These cases have reminded me of my first paper (Tse HF et al, Am J Med Sci 1996;312(4):182–6), which was published as a case report of a boy who died of refractory ventricular tachycardia due to hypertrophic cardiomyopathy. This was suspected to be caused by glycogen storage diseases. Indeed, both the clinical phenotype and histological findings of this case were regarded as Danon disease.

You have held academic appointments for nearly two decades; what are the key things that you like to emphasise to your trainees?

As a clinical scientist, my main objective for supervision of research students is to nurture them not only with skill and knowledge but also life-long enthusiasm for medical research. My approach to achieving this goal is to show them my own passion and enthusiasm. As each student comes from different backgrounds and have different needs, I teach each student as an individual. Although I hope to inspire some young talent to continue in medical research, the majority of those who join our research programme continue in medical professional. Nevertheless, I believe that critical thinking and problem solving are the most rewarding experiences during all of the research activities. More importantly, those skills are also crucial factors for success in their careers. Furthermore, the personal enthusiasm for research is also an important learning experience for own professional development.

As co-chairman of CardioRhythm (30 January–1 February 2015, Hong Kong), could you tell us what the highlights of this year’s conference were?

At CardioRhythm 2015, delegates learned on the latest technologies for mapping and ablation of cardiac arrhythmias. Advances in novel device therapies-such as leadless pacemaker and subcutaneous ICD-were also be discussed. Additionally, there were sessions on remote monitoring of devices and heart failure monitoring; management of device and lead related complications; and the latest developments on anticoagulation for atrial fibrillation were showcased.

In your view, what are the three “general medicine” concepts that cardiac rhythm management specialists need to think about?

Preventive measures are more important than therapeutic procedures;

For therapeutic interventions, sometimes less is more for your patient, and

Sometimes we need to think outside the box.

What are the key challenges that electrophysiology as a speciality faces in Hong Kong?

While most of the hospitals in Hong Kong have services in pacing and clinical electrophysiology, there are a few cardiologists that are fully dedicated clinical electrophysiologists. Moreover, we only have a small number of trainees in clinical electrophysiology in most of the labs in Hong Kong.